A retrospective review of patients receiving rituximab off label in a large teaching hospital was conducted between July 2002 and January 2006. The indication, dosing regimen, efficacy and cost of rituximab were evaluated. Rituximab was prescribed for three clinical indications; acute organ transplant rejection, post-transplant lymphoproliferative disease and autoimmune disease. On average, 600 mg of rituximab was prescribed weekly for 4 weeks, costing the hospital $108,739.37. We suggest an initial approval for a limited number of doses with subsequent approval dependent on improvement in predefined clinical or biochemical end-points. Furthermore, we suggest an Australia-wide central database be established to enable delineation of the optimal dosing schedule, as well as monitoring of clinical outcome.

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Aim: To obtain an overview of the pharmacy workload measurement systems (WMS) operating in Australian hospitals. Method: Telephone interviews were conducted in November 1994 in 61 hospital pharmacy departments which were randomly selected from The Society of Hospital Pharmacists of Australia (SHPA) Resources Directory 1994-95. An introductory letter and a questionnaire were mailed to the director of each department one week before the telephone interview. Data were analysed qualitatively and quantitatively. Results: The response rate was 82%. Workload was measured in 88% of departments. The activities measured varied, with dispensing being the most measured activity (98%). Number of items and occasions of service were used by all respondents as the major units of measurement. Eighty-six per cent of departments submitted workload information to external bodies. Information relating to the strengths and weaknesses of systems used and pharmacy staff attitudes on WMS were also expressed by respondents. Sixty-one per cent of departments would like to make some change to their current systems. Fifty-five per cent indicated that they would support a national hospital pharmacy WMS and conditional support was given by 44%. Conclusion: There is opportunity for SHPA to assume leadership in developing and introducing a national hospital pharmacy WMS for the profession.

Prospective drug chart review by pharmacists is an important risk minimisation strategy in the detection and prevention of prescribing medication incidents (PMis). Feedback reporting to the clinical team facilitates learning from and the identification and prevention of system-based PMis. At Westmead Hospital, Sydney, the establishment of a relational database ofprevented-PMis in November 2001 enabled such feedback reporting. Assessment of the reporting process after 12 months indicated review and application of the data within quality frameworks, value in improving prescribing practice and continued interest in receiving the reports. Implementation of feedback reporting has facilitated learning from PMis beyond the prescriber to the team and organisational levels. PMI data have been incorporated into 'safe prescribing' training programs for junior doctors. The proactive role of the clinical pharmacist in ensuring safe medication outcomes has been highlighted. Establishment of data management and reporting processes may assist future incorporation into wider incident-monitoring systems.